iatroX Rounds #17
The clues
- 1
A 32-year-old woman presents with a three-week history of numbness and tingling in both legs and persistent fatigue.
- 2
She mentions a previous episode six months ago where she experienced painful loss of central vision in her left eye that improved over several weeks.
- 3
She notices that her neurological symptoms, particularly her coordination and balance, seem to worsen temporarily after taking a hot bath or during exercise.
- 4
On examination of horizontal gaze, there is impaired adduction of the right eye with coarse nystagmus of the abducting left eye.
- 5
MRI of the brain and spinal cord reveals multiple hyperintense plaques in the periventricular, juxtacortical, and infratentorial regions on T2-weighted imaging.
- 6
Analysis of the cerebrospinal fluid reveals a normal total protein and cell count but shows the presence of IgG oligoclonal bands that are not found in a matched serum sample.
Multiple sclerosis is a chronic autoimmune disease characterized by demyelination within the central nervous system. It typically presents in young adults with neurological deficits that are disseminated in both time and anatomical space.
- Optic neuritis characterized by painful vision loss and a relative afferent pupillary defect
- Uhthoff's phenomenon where symptoms worsen with increased body temperature
- Internuclear ophthalmoplegia due to lesions in the medial longitudinal fasciculus
- Lhermitte's sign which is an electric shock-like sensation radiating down the spine on neck flexion
for education and entertainment. not medical advice.